Federal Legislative Issues Update - Dec 2006
December 2006
Washington Highlights
The U.S. Congress finished all its heavy lifting for the 109th Congress with a late-night legislative marathon ending by 5:00 a.m. Saturday, December 9, 2006. The lame duck session concluded with passage of the Tax Relief and Health Care Act of 2006 (H.R. 6111), which included Medicare provisions addressing the therapy caps and Medicare payments. Also included in the bill were measures addressing tax extenders, trade provisions, certain expiring energy provisions, provisions designed to improve health savings accounts, and miscellaneous items.
Congress also passed other bills during the last week of the lame duck session, including: a continuing resolution to February 15, 2007, on all unfinished appropriations bills for FY 2007; legislation on autism funding; National Institutes of Health (NIH) reauthorization; funding for the State-Child Health Insurance Program (S-CHIP); the Lifespan Respite Act; and mental health "partial parity" extenders. Read more below about these bills.
The new 110th Congress is set to convene under Democratic leadership on January 4, 2007. Watch the American Occupational Therapy Association (AOTA) Legislative Action Center for a preview of AOTA's 2007 legislative agenda.
Congress Passes the Tax Relief and Health Care Act of 2006
AOTA, membership, staff, and consumers were all victorious in their work to get the Tax Relief and Health Care Act of 2006 (H.R. 6111) passed by Congress. On Friday, December 8, the U.S. House of Representatives passed H.R. 6111 by a vote of 367-45, and the Senate followed with an early-morning vote on Saturday, December 9, by a vote of 79 to 9. Below is a summary of the H.R. 6111 provisions that will have an impact on occupational therapy.
AOTA Victorious on Therapy Cap Exceptions Extension
Included under the Medicare provisions is a 1-year extension of the Medicare Part B outpatient occupational therapy cap exceptions process supported by AOTA. The therapy cap exceptions process extension will be the same as the system that was passed in the Deficit Reduction Act of 2005.
The success of extending the therapy cap exceptions process is largely due to AOTA staff and grassroots lobbying. Members of Congress felt the pressure from their constituency to fix the caps before Congress reconvenes in January 2007.
AOTA and its membership will have to continue the fight in the 110th Congress. Because the extension is for only 1 year, AOTA and provider and consumer groups will have to continue to work to develop an appropriate long-term solution.
Continue to watch the AOTA Legislative Action Center for updates and further details about the 2007 agenda. Contact the AOTA Federal Affairs staff with any questions or comments at fad@aota.org or 1-800-SAY-AOTA.
Scheduled Medicare Payment Cuts Avoided
Also included under the Medicare provisions is language that provides a 1-year, 0% update for 2007 to providers in Medicare, including services provided by occupational therapists and therapy assistants, thus avoiding a scheduled 5% cut.
The provisions also establish a quality reporting system for eligible professionals who use consensus-based quality measures during 2007, beginning July 1, 2007, through December 31, 2007. Physicians and other eligible practitioners who submit data on applicable quality measures will receive bonus incentive payments of 1.5% for covered services, beginning July 1, 2007, through December 31, 2007.
AOTA is working with the Centers for Medicare & Medicaid (CMS) to further explain the implications of this language to occupational therapists. Continue to watch the AOTA Legislative Action Center for more details as they are made available.
Mental Health "Partial Parity" Extension Passed
Congress also passed an extension to current "partial parity" for 1 year. The current legislation, originally passed in 1996, requires that benefits for mental health care be on par with physical health services, but does not address differing co-payment, day and visit limitations, or deductibles. This bill maintains the status quo; an extension was important to keep the existing baseline and to not slip back before attempts to address true mental health parity begin in January 2007, when the Democrat-controlled 110th Congress convenes. AOTA remains active in support of true mental health parity and will work with Representatives Patrick Kennedy (D-RI) and Jim Ramstad (R-MN) in the House of Representatives, as well as Senators Ted Kennedy (D-MA) and Pete Domenici (R-NM) in the Senate in order to pass mental health and substance abuse parity efforts in the 110th Congress.
National Institutes of Health (NIH) Reauthorization Passes in Lame Duck Session
A compromise between Senate and House negotiators led to passage of the National Institutes of Health Reform Act of 2006 (H.R. 6164). The legislation would reauthorize the NIH for the next several years. Many of the provisions in the original bill that passed the House of Representatives-provisions that scientific and patient advocacy organizations found egregious-were modified in such a way that lawmakers in both the House and Senate found acceptable. A summary of key provisions and compromises follows:
- Establishes the NIH Director's Common Fund, but eliminates the 50/50 formula included in the original House bill that would have tied funding for the Common Fund to overall NIH appropriations. Instead, the bill requires the NIH Director to establish a reserve account to fund the Common Fund, subject to a specific appropriation. In this manner, funding for the Common Fund will not come at the expense of what is made available annually for individual institutes and centers.
- Increases the dollar level for authorizations of appropriations (which were capped at 5% in the original bill) for FY 2007 and 2008, and authorizes "such sums as may be necessary" for FY 2009. These changes were significant in that, historically, NIH's budget has grown at a rate of more than 5% annually. Although it may be difficult for the Appropriations Committees to reach the authorization levels with actual funding in the current fiscal environment, the appropriators did not want the bill to set such low caps, establishing a precedent for low levels of increases.
- The bill maintains House-passed provisions creating the overall funding authority for NIH instead of the individual institutes, but members of the Appropriations Committees have said that they will continue to fund institutes and centers individually.
- Eliminates the provision from the original House bill that would have allowed the NIH Director to reconfigure, eliminate, or reorganize institutes and centers at NIH. Many groups expressed concern that the NIH director should not have that authority. Negotiators agreed, and eliminated the provision. Current law, which allows the Secretary of the U.S. Department of Health and Human Services (HHS) to reconfigure institutes and centers, would be maintained. Most groups are comfortable with that arrangement because the HHS Secretary has generally not acted on that authority, and any reorganization at that level would be subject to a much more public process.
- Modifies the provision that would allow individual institute and center directors to reconfigure and reorganize programs with their institute or center. The final bill calls for any institute or center director who wishes to initiate major changes to engage in a public process by receiving input from patient advocacy, scientific, and other interested parties; and to secure the approval of the Director of the NIH.
- Establishes a Scientific Management Review Board to periodically review the configuration of the NIH and make recommendations to key officials every 7 years.
- Establishes a more comprehensive reporting system for the NIH in terms of spending on various diseases, and the management of data and statistics. Requires the NIH Director to report to Congress on progress on key areas of health, but includes a provision that would allow individual institutes and centers to report directly to Congress, as well.
- Establishes a Bridging the Sciences Initiative, a High Risk-High Reward Initiative, and a Public-Private Partnerships Initiative.
- Includes a provision modifying the Clinical and Translational Science Award program to preserve independent funding and infrastructure for pediatric clinical research centers.
Congress Addresses S-CHIP Shortfall To Ensure Continued Access to Care for Children
The shortfall expected in the State-Child Health Insurance Program (known as S-CHIP of CHIP) was another issue resolved, at least temporarily, by Congress before adjourning for the year. As many as 17 states facing CHIP funding shortfalls in 2007, and 600,000 low-income children would have been at risk of losing health insurance coverage if Congress had not passed the NIH Reform Act of 2006 (H.R. 6164), which included the CHIP Shortfall Reduction Package.
The bill redistributes remaining unclaimed CHIP money from FY 2004 and 2005 to states that will have shortfalls in 2007. States expected to have shortfalls next year include Connecticut, Hawaii, Maryland, Minnesota, New Hampshire, New Mexico, Rhode Island, Tennessee, Vermont, Washington, and Wisconsin.
The redistributed money is expected to meet the shortfall until at least May 2007, but Congressional action is necessary next year to ensure continuing coverage for children in the program after that date. Members of Congress are expected to reauthorize CHIP next year, so they will have the opportunity to address the shortfall again during that process or through some other legislative vehicle as necessary. The legislation passed along bipartisan lines, largely because the bill uses existing funds and does not constitute new spending. AOTA will remain actively engaged in support of CHIP during the 110th Congress.
Congress Passes Funding for Autism
The Combating Autism Act (S. 843), supported by AOTA, passed the Senate and House of Representatives and can now be sent to the President's desk to be signed into law.
The bill authorizes roughly $1 billion over the next 5 years to combat autism through research, screening, early detection, and intervention. The law will double federal spending on autism. The Combating Autism Act includes provisions relating to the diagnosis and treatment of persons with autism and autism spectrum disorders, improves funding for biomedical research, and focuses additional research on possible environmental causes for autism.
Lifespan Respite Act Now Goes to President's Desk To Be Signed Into Law
The Lifespan Respite Care Act-legislation supported by AOTA since its introduction 4 years ago-was passed during the closing hours of the 109th Congress. The Act provides almost $300 million over 5 years for grants for states and local agencies. These grants will be used to increase the availability of respite care services for family caregivers of persons with special needs throughout the life span. The bill also promotes a coordinated system of accessible respite care at the state and federal level, and designates the Agency on Aging as the lead for each of the grants. Representatives Michael Ferguson (R-NJ) and Jim Langevin (D-RI) sponsored the bill in the House, while Senators Hillary Clinton (D-NY), John Warner (R-VA), and Olympia Snowe (R-ME) led the effort in the Senate. The bill has been endorsed by more than 180 national and regional organizations, including AOTA. The bill now goes to the President's desk to be signed into law.
AOTPAC
Paul Fontana, Chair of AOTPAC (AOTA's Political Action Committee), will end his term on December 31, 2006, and Amy Lamb will assume the Chair position on January 1, 2007. We want to take this opportunity to thank Mr. Fontana for all his work on behalf of the AOTPAC and the members of AOTA. Some of his efforts included: increased AOTA leadership participation and support of AOTPAC; more participation by student members of AOTA; initiation of the Dollar-A-Day contribution program; increased AOTPAC participation at state association conferences around the country; and increased communication with contributors.
AOTPAC is still seeking contributions for the 2006 calendar year to meet its fund-raising goal of $225,000. As of December 11, 2006, AOTPAC still needs to raise just under $10,000 to make its goal. All AOTA members are urged to help by making a contribution before the end of 2006. Contribute at the AOTA Web site. If 10 people gave $1,000 or 20 gave $500, we'd easily reach our goal. Please help today with whatever you can.
Do you have a grassroots advocacy story to tell? Do you know or have a connection to your Senators or Representatives? Contact AOTA's Federal Affairs Department and share your experience! E-mail: fad@aota.org, Mail: PO Box 31220, Bethesda, MD 20824-1220, Telephone: 800-729-2682, or Fax: 301-652-7711.
Last Update: 12/16/06